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Aortic dissection with malperfusion — RCPSC EM MCQ

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HardCardiovascular emergenciesAortic dissection with malperfusionRCPSC EM

CTAS 1: A 59-year-old has abrupt tearing chest pain radiating to the back. Vitals are BP 198/104 right arm and 162/86 left arm, HR 112. Neurologic exam shows transient left leg weakness; creatinine is elevated. CXR shows widened mediastinum and ECG has no STEMI. What is the most likely diagnosis?

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Correct answer: A — Acute aortic dissection

Abrupt severe pain, pulse or BP differential, neurologic symptoms and mediastinal widening strongly suggest dissection. Management prioritises impulse control and urgent CTA/surgical consultation.

Reference: Canadian cardiovascular emergency practice; Royal College EM Objectives